Two 66-year-old twins on Medicare, both with a family history of Alzheimer’s, represent a scenario where early diagnosis is crucial for long-term care. Medicare covers cognitive screening during annual wellness visits, leading them to believe they would receive a timely diagnosis if necessary.
However, a new study highlights that geographic location significantly impacts the likelihood of receiving an Alzheimer’s diagnosis, with one twin in Hartford, Connecticut, being 18% more likely to be diagnosed compared to her sister in nearby Springfield, Massachusetts.
The study, led by Julie Bynum from the University of Michigan, found that Connecticut’s healthcare system may be more effective at diagnosing Alzheimer’s and referring patients to specialists than Massachusetts. This disparity in diagnostic rates is not unique to these states but is seen across the United States.
The study revealed that diagnostic intensity, or the frequency with which doctors offer tests and treatments, varies by ZIP code, with some areas having twice the likelihood of diagnosing dementia as others.
Regions with the lowest diagnostic intensity have a 28% lower chance of timely dementia diagnosis compared to the national average, while those with the highest intensity are 36% more likely to diagnose Alzheimer’s or other forms of dementia.
Bynum emphasizes that these differences in diagnosis rates are unrelated to patient risk factors, suggesting systemic variations in healthcare practices across different areas. The inability to diagnose early can prevent patients from accessing necessary education, planning, and medical interventions.
The study sheds light on the inequities in healthcare, with individuals receiving different levels of care based on where they live. Dr. Eseosa Ighodaro from Atrium Health Wake Forest Baptist Medical Center highlights that these disparities are particularly concerning given the availability of new medications for Alzheimer’s since 2021.
Early diagnosis is vital for patients to benefit from these treatments, and without addressing these regional differences, many may miss out on potentially life-changing therapies.
The research also found that traditional patterns of higher Alzheimer’s diagnoses in the Southeast, known as the “stroke belt,” may no longer fully explain the distribution of cases across the country.
Bynum’s analysis of Medicare data across 306 hospital referral regions found that areas like Alaska, Connecticut, and the Texas Panhandle align well with expected dementia diagnoses based on risk factors, while Florida, surprisingly, does not.
The study discovered significant disparities in diagnosis rates, particularly in younger seniors (ages 66-74) and among Black and Hispanic populations, who are at a higher risk of dementia. Even within racial groups, the likelihood of diagnosis varied greatly depending on the ZIP code, pointing to broader issues within healthcare systems beyond just demographic factors.
Insurance coverage and healthcare system capabilities also play roles in these disparities. Even though all patients in the study had Medicare, differences in hospital and specialist availability and acceptance of Medicare could lead to unequal access to diagnostic tests. Additionally, the stigma around cognitive decline and the complexity of diagnosing dementia can further complicate the situation for both doctors and patients.
To address these disparities, patients and their families are encouraged to be proactive about their cognitive health, seeking out doctors and hospitals that provide comprehensive cognitive assessments during wellness visits.
Being informed and advocating for necessary tests and referrals is crucial for ensuring timely diagnosis and access to new treatments that can significantly improve the quality of life for those at risk of Alzheimer’s and other dementias.
